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We report on anomalously long duration (2 ms) count rate bursts following the impact of cosmic ray showers near a 7.62 cm x⊘7.62 cm LaBr3 scintillation detector at the High Altitude Water Cherenkov array in Mexico, previously described by Stenkin et al. (2001), and termed "neutron bursts." The largest burst produced 198 counts within 2 ms in our LaBr3 detector. We simulate the neutron burst albedo flux (that is, secondary emissions from an extensive air shower core impacting the ground), and show that (1) the characteristic spectra and count rates are well explained by neutron absorption in the ground and (2) any cosmic ray secondary that produces neutrons, either through hadron inelastic collisions, or photoneutron production by gamma‐rays, produces the same characteristic spectra. This implies that other natural phenomena that produce downward beams of gamma‐rays, like Terrestrial gamma ray flashes, should produce a similar "neutron burst" signature from the photoneutron reactions occurring in the soil. Plain Language Summary: When very large cosmic ray showers (CRS) impact the ground, neutrons are produced in the soil that will rattle around until they become captured by soil particles and release energetic gamma‐rays. This produces a slow explosion of particles emanating from the ground following a CRS impact, and is termed a 'neutron burst'. We present recent observations of neutron bursts from a hand held sized gamma‐ray detector at the High Altitude Water Cherenkov (HAWC) array in Mexico, that exhibit interesting spectral features (the presence of positron annihilation), and an interesting time structure (hundreds of counts within a few ms). Our simulations indicate that Terrestrial gamma‐ray flashes (TGFs, bursts of gamma‐rays associated with lightning) should also produce these neutron bursts. An implication of this work is that existing deployments of ground based TGF instruments, comprised of small gamma‐ray detectors, can additionally be used to observe signatures of large cosmic ray showers on clear days. Key Points: We report on fairweather count rate bursts with 2 ms duration following the impact of a large cosmic ray shower near a small scintillation detector at HAWCSimulations show that the spectra and decay time can be produced by either hadronic interactions, or photoneutron reactions from gamma‐raysThese results imply that downward TGFs could produce a similar delayed neutron signature in the soil near ground based detectors [ABSTRACT FROM AUTHOR]

Background: HIV pretreatment drug resistance (PDR) to NNRTIs in persons initiating ART is increasing in Mexico., Objectives: To compare HIV PDR in eight sub-regions of Mexico., Patients and Methods: A large PDR survey was implemented in Mexico (September 2017-March 2018) across eight sub-regions. All larger clinics (which provide ART to 90% of all initiators) were included, allocating sample size using the probability-proportional-to-size method. Both antiretroviral-naive and prior antiretroviral-exposed persons were included. HIV PDR levels were estimated from pol Sanger sequences obtained at a WHO-designated laboratory., Results: A total of 2006 participants were enrolled from 74 clinics. PDR to NNRTIs was higher than to other drug classes (P < 0.0001), crossing the 10% threshold in the North-East, East, South-West and South-East. NNRTI PDR was higher in the South-West (P = 0.02), coinciding with the highest proportion of restarters in this sub-region (14%). We observed higher PDR prevalence to any drug in women compared with men (16.5% versus 12.2%, P = 0.04). After multivariable adjustment, higher NNRTI PDR remained significantly associated with previous antiretroviral exposure in the Centre-North, North-West, South-West and South-East [adjusted OR (aOR): 21, 5, 8 and 25, respectively; P < 0.05]. Genetic network analyses showed high assortativity by sub-region (P < 0.0001), with evidence of drug resistance mutation transmission within local clusters., Conclusions: Diversification of the public health response to HIV drug resistance based on sub-regional characteristics could be considered in Mexico. Higher NNRTI PDR levels were associated with poorer regions, suggesting opportunities to strengthen local HIV programmes. Price and licensing negotiations of drug regimens containing integrase inhibitors are warranted., (© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)